A variety of surgical procedures have been devised for the closure of the oroantral fistula. The majority of these methods have employed buccal or palatal mucoperiosteal flaps or combinations of both. Though generally successful in closing the oroantral fistula, these flap procedures occasionally fail, especially in those cases with unusually large openings. These flaps may also alter the intra-oral anatomy making the construction of intra-oral appliances difficult. After eliminating those failures due to persistant infection or inadequate drainage of the maxillary sinus, there remains that group of patients whose oroantral fistula closure fails, due to inherent inadequacies of the procedure used; therefore, we have endeavored to find a surgical technique that will give us more reliable results. Through our endeavors we found a simplified technique for the closure of oroantral fistulas using gold foil, a method recently advocated in the dental literature. The surgical procedure consists of denuding the margins of the oroantral fistula of all mucoperiosteum and covering the opening with an overlapping margin of 36-gauge gold foil. The mucoperiosteal flaps elevated to expose the bony margins of the fistula are then sutured loosely over the foil to act as an envelope holding the gold in place. Mucosa from the maxillary sinus migrates across the inner surface of the foil providing closure on one side. Gradually, the mucoperiosteal flap retracts, exposing the gold foil but still maintaining it in its proper position. After several weeks the foil is removed, showing an intact sinus mucosal lining. In an additional few weeks the mucoperiosteum grows over the sinus mucosa giving a two-layered closure. We have had successful results in seven patients treated by this method, some of whom were failures of a standard flap technique and all of which were quite large. The advantages of this procedure are that it is a safe, simple and physiologic method of closing oroantral fistulas without distorting intra-oral anatomy, and we feel that it should receive wider attention by otolaryngologists in the future.
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